Provider Demographics
NPI:1366617664
Name:FADEM, CARMEN LAUDA (MD)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:LAUDA
Last Name:FADEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-3208
Mailing Address - Country:US
Mailing Address - Phone:828-288-6800
Mailing Address - Fax:
Practice Address - Street 1:150 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-3208
Practice Address - Country:US
Practice Address - Phone:828-288-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE56485Medicare UPIN